N.Y. Insurance Law Section 4306
Required contract provisions


Every contract issued by any corporation pursuant to the provisions of § 4304 (Individual contracts)section four thousand three hundred four of this article, shall be in writing and shall state the terms and conditions thereof. No such contract shall be made, issued or delivered in this state unless it contains the following provisions:

(a)

a statement of the amount payable to the corporation by the individual to whom the contract is issued and the times at which and manner in which such amount is to be paid;

(b)

a statement of the nature of the benefits to be furnished and the period during which they will be furnished; and if there are any benefits to be excepted, a detailed statement of such exceptions printed as hereinafter specified;

(c)

a statement of the terms and conditions, if any, upon which the contract may be terminated at the option of the individual, or otherwise terminated at the option of either party as permitted by subsection (b) or (c) of § 4304 (Individual contracts)section four thousand three hundred four of this article;

(d)

a statement that the contract includes the endorsements thereon and attached papers, if any;

(e)

a statement that no statement by the individual in his application for a contract shall avoid the contract or be used in any legal proceeding thereunder, unless such application or an exact copy thereof is included in or attached to such contract, and that no agent or representative of such corporation and no broker, other than an officer or officers designated therein, is authorized to change the contract or waive any of its provisions;

(f)

a statement that if the individual defaults in making any payment under the contract, the subsequent acceptance of a payment by the corporation or by one of its duly authorized agents or by a duly authorized broker shall reinstate the contract, but with respect to sickness and injury, only to cover such sickness as may be first manifested more than ten days after the date of such acceptance;

(g)

a statement of the period of grace which will be allowed the individual for making any payment due under the contract which period shall not be less than ten days;

(h)

a statement on the first page of the contract or in a notice attached to the contract that during a specified period of time, which shall not be less than ten days nor more than twenty days from the date the contract is delivered to the individual, it may be surrendered to the corporation together with a written request for cancellation of the contract and that in such event the corporation will refund any premium paid therefor including any contract fees or other charges; provided, however, that a contract sold by mail order and a contract providing medicare supplemental insurance or long-term care insurance must contain a provision permitting the individual a thirty day period for such surrender;

(i)

the age limit or date or period, if any, after which the coverage provided by the contract will not be effective, or renewed, is stated in a renewal provision set forth on the first page of the contract or as a separate provision bearing an appropriate caption on the first page on the contract or in a brief description in not less than fourteen point bold face type set forth on the first page of the contract; nothing herein contained shall limit or restrict the right of the corporation to continue the contract after the age or period so stated;

(j)

a statement under the caption “CONVERSION PRIVILEGE” which shall set forth in substance the conversion privileges and related provisions required by subsections (d) and (e) of § 4304 (Individual contracts)section four thousand three hundred four of this article;

(k)

the exceptions of the contract shall appear with the same prominence as the benefits to which they apply;

(l)

if the contract contains any provision purporting to make any portion of the articles, constitution or by-laws of the corporation a part of the contract, such portion shall be set forth in full; and

(m)

in every such contract made, issued or delivered in this state there shall be a brief description of the contract on its first page and on its filing back.

(n)

a statement that a health care claim from a subscriber shall be submitted within one hundred twenty days from the date of service; provided, however, that if it was not reasonably possible for the subscriber to submit the claim within that timeframe, then the claim shall be submitted as soon as reasonably possible. * (o) Space shall be provided on any enrollment, renewal or initial online portal process setup forms required of a subscriber or applicant for coverage, except forms issued by the NY State of Health, the official Health Plan Marketplace, other than those specifically referenced in subparagraph (iv) of paragraph (a) of subdivision five of section forty three hundred ten and paragraph (v) of subdivision one of Public Health Law § 206 (Commissioner)section two hundred six of the public health law, so that the subscriber or applicant for coverage shall register or decline registration in the donate life registry for organ, eye and tissue donations under this section of the enrollment, renewal or initial online portal process setup forms and that the following is stated on the form in clear and conspicuous type: “You must fill out the following section: Would you like to be added to the Donate Life Registry? Check box for ’yes’ or ’skip this question’.” * NB Effective January 1, 2026

Source: Section 4306 — Required contract provisions, https://www.­nysenate.­gov/legislation/laws/ISC/4306 (updated Jul. 5, 2024; accessed Dec. 21, 2024).

4301
Organization of corporation
4302
Permit and license to do business
4303
Benefits
4303‑A
Prescription synchronization
4304
Individual contracts
4305
Group contracts
4306
Required contract provisions
4306‑A
Health insurance coverage for full-time students on medical leaves of absence
4306‑B
Primary and preventive obstetric and gynecologic care
4306‑C
Grievance procedure and access to specialty care
4306‑D
Choice of health care provider
4306‑E
Prohibition on lifetime and annual limits
4306‑F
Maternal depression screenings
4306‑G
Telehealth delivery of services
4306‑H
Essential health benefits package and limit on cost-sharing
4306‑I
Coverage for medically fragile children
4307
Providers of services
4308
Supervision of superintendent
4309
Limitation on expenses
4310
Investments
4312
Employment of solicitors
4313
Applicability of other provisions of this chapter
4314
Not to affect provisions of workers’ compensation law
4315
Arbitration
4316
Individual contracts
4317
Rating of individual and small group health insurance contracts
4318
Pre-existing condition provisions
4318‑A
Certification of creditable coverage by corporations organized under this article
4320
Limitations on administrative services and stop-loss coverage
4321
Standardization of individual enrollee direct payment contracts offered by health maintenance organizations prior to October first, two t...
4321‑A
Fund for standardized individual enrollee direct payment contracts
4322
Standardization of individual enrollee direct payment contracts offered by health maintenance organizations which provide out-of-plan ben...
4322‑A
Fund for standardized individual enrollee direct payment contracts which provide out-of-plan benefits
4323
Marketing materials
4324
Disclosure of information
4325
Prohibitions
4326
Standardized health insurance contracts for qualifying small employers and individuals
4327
Stop loss funds for standardized health insurance contracts issued to qualifying small employers and qualifying individuals
4328
Individual enrollee direct payment contracts offered by health maintenance organization on and after October first, two thousand thirteen
4329
Prescription drug coverage
4330
Discrimination because of sex or marital status in hospital, surgical or medical expense insurance

Accessed:
Dec. 21, 2024

Last modified:
Jul. 5, 2024

§ 4306’s source at nysenate​.gov

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